Perplexed by PGx? Exploring the impact of pharmacogenomic results on medical management, disclosures and patient behavior

Pharmacogenomic (PGx) tests represent significant advances in precision medicine. Our aim was to explore perceptions following the return of PGx results, medication management, and disclosure to providers. We surveyed clients who had PGx testing and conducted a chart review of PGx results. Respectively, 84% and 94% of participants found pre- and post-test genetic counseling helpful. There was a significant difference in disclosure, while 6% disclosed results to a pharmacist, 50% disclosed to a physician. Qualitative analysis identified three themes: 1) psychological response; 2) perceived utility; 3) experiences with disclosure. Our study supports the provision of genetic counseling for a non-disease related genetic test. Benefits of PGx testing can be optimized by the collaboration of physicians, pharmacists, genetic counselors and patients.

The Personal Genome Project Canada: findings from whole genome sequences of the inaugural 56 participants

BACKGROUND

The Personal Genome Project Canada is a comprehensive public data resource that integrates whole genome sequencing data and health information. We describe genomic variation identified in the initial recruitment cohort of 56 volunteers.

METHODS

Volunteers were screened for eligibility and provided informed consent for open data sharing. Using blood DNA, we performed whole genome sequencing and identified all possible classes of DNA variants. A genetic counsellor explained the implication of the results to each participant.

RESULTS

Whole genome sequencing of the first 56 participants identified 207 662 805 sequence variants and 27 494 copy number variations. We analyzed a prioritized disease-associated data set (n = 1606 variants) according to standardized guidelines, and interpreted 19 variants in 14 participants (25%) as having obvious health implications. Six of these variants (e.g., in BRCA1 or mosaic loss of an X chromosome) were pathogenic or likely pathogenic. Seven were risk factors for cancer, cardiovascular or neurobehavioural conditions. Four other variants - associated with cancer, cardiac or neurodegenerative phenotypes - remained of uncertain significance because of discrepancies among databases. We also identified a large structural chromosome aberration and a likely pathogenic mitochondrial variant. There were 172 recessive disease alleles (e.g., 5 individuals carried mutations for cystic fibrosis). Pharmacogenomics analyses revealed another 3.9 potentially relevant genotypes per individual.

INTERPRETATION

Our analyses identified a spectrum of genetic variants with potential health impact in 25% of participants. When also considering recessive alleles and variants with potential pharmacologic relevance, all 56 participants had medically relevant findings. Although access is mostly limited to research, whole genome sequencing can provide specific and novel information with the potential of major impact for health care.

Assessment of bioaccumulation and neurotoxicity in rats with portacaval anastomosis and exposed to manganese phosphate: a pilot study

The use of the additive methylcyclopentadienyl manganese tricarbonyl in unleaded gasoline has resulted in increased attention to the potential toxic effects of manganese (Mn). Hypothetically, people with chronic liver disease may be more sensitive to the adverse neurotoxic effects of Mn. In this work, bioaccumulation of Mn, as well as histopathology and neurobehavioral damage, in end-to-side portacaval anastomosis (PCA) rats exposed to Mn phosphate via inhalation was investigated. During the week before the PCA operation, 4 wk after the PCA operation, and at the end of exposure, the rats were subjected to a locomotor evaluation (day-night activities) using a computerized autotrack system. Then a group of 6 PCA rats (EXP) was exposed to 3050 microg m(-3) (Mn phosphate) for 8 h/day, 5 days/wk for 4 consecutive weeks and compared to a control group (CON), 7 PCA rats exposed to 0.03 microg m(-3). After exposure, the rats were euthanized and Mn content in tissues and organs was determined by neutron activation analysis. The manganese concentrations in blood (0.05 microg/g vs. 0.02 microg/g), lung (1.32 microg/g vs. 0.24 microg/g), cerebellum (0.85 microg/g vs. 0.64 microg/g), frontal cortex (0.87 microg/g vs. 0.61 microg/g), and globus pallidus (3.56 microg/g vs. 1.33 microg/g) were significantly higher in the exposed group compared to the control group (p <.05). No difference was observed in liver, kidney, testes, and caudate putamen between the two groups. Neuronal cell loss was assessed by neuronal cell counts. The loss of cells in globus pallidus and caudate putamen as well as in frontal cortex was significantly higher (p <.05) for the EXP group. Assessment of the locomotor activities did not reveal any significant difference. This study constitutes a first step toward our understanding of the potential adverse effects of Mn in sensitive populations.

Structural characterisation of the H-bonded [MnII(OH2)2...(OCH3)2MnIII] motif: a model for resting state hydroxylic solvent coordination in M(II)-M(III) enzymes

A mixed-valence dimanganese complex with two water ligands bound to the Mn(II) ion and two methoxide ligands bound to the Mn(III) ion in a H-bonded arrangement has been structurally characterised and models possible resting state water/hydroxide coordination in purple acid phosphatases.

5-(2-pyridyl)-1,3-dithiane-2-thione

The title compound, C9H9NS3, crystallizes with two molecules in the asymmetric unit. In both molecules, the dithiane-2-thione rings adopt a symmetric half-boat conformation with the C atom opposite the C--S(thione) bond out of the plane. The pyridine ring is in an equatorial position and is twisted out of the plane of the half-boat by 82.7 (2) and 84.5 (2) degrees in the two molecules, so that the N atom is trans to the axial C--H bond in both cases.

Polymeric[mu(3)-(N-phosphonomethyl)-glycinato]tris(tri-n-butyltin)

N-(Phosphonomethyl)glycine, glyphosate, reacts with bis(tributyltin) oxide to form a ligand--tin (1:3) complex in which all five O atoms are coordinated to tin. The complex, [Sn(3)(C(4)H(9))(9)(C(3)H(5)NO(5)P)], is polymeric, with the glyphosate and two tributyltin groups forming a two-dimensional network and with the third Sn atom alternately above and below the plane of the net. The Sn atoms in the network have a trigonal-bipyramidal coordination, with O atoms in the axial positions and C atoms in the equatorial positions; the pendant tributyltin group is tetrahedrally coordinated to one O atom and to three butyl groups. Sn--O distances vary from 2.030 (3) to 2.408 (3) A. The Sn--O distances for O atoms trans to carboxylate groups are shorter than those trans to phosphonate groups and d(Sn--O) decreases with increasing d(C/P--O) (Delta(Sn--O) approximately -4.6 Delta(C/P--O)). The amino N atom in the ligand is neither protonated nor involved in coordination to the Sn atoms.

Two polymorphs of aqua[N,N'-ethylenebis(salicylideneaminato-N,O)]-oxovanadium(V) nitrate

The title compound, aqua[bis(salicylidene)ethylenediaminato-O,N,N',O']oxovanadium(V) nitrate, [VO(C(16)H(14)N(2)O(2))(H(2)O)]NO(3), crystallizes as two polymorphs in the triclinic and monoclinic crystal systems. In both, the V atom has a distorted octahedral coordination geometry with a long V--O(water) bond trans to V==O. The coordinated water molecules are hydrogen bonded to the nitrate ions so that pairs of cations are linked to give neutral centrosymmetric dimers. The V==O and V--O(water) distances are 1.598 (2) and 2.257 (2) A, respectively, in the triclinic form, and 1.588 (3) and 2.230 (3) A, respectively, in the monoclinic form. In the triclinic form, the dimers pack so that the salen [bis(salicylidene)ethylenediaminate] ligands are parallel to each other, whereas in the monoclinic form, which is the denser, there is a herring-bone arrangement.

Preparation and crystal structures of formato complexes of the [MIV3O4]4+ and [MIV3S4]4+ (M = Mo, W) clusters. Convenient precursors to the corresponding aqua complexes

In the aqueous chemistry of molybdenum(IV) and tungsten(IV), trinuclear, incomplete cubane-like, oxo and sulfido clusters of the type [M3E4]4+ (M = Mo, W; E = O, S) play a central role. We here describe how formato complexes of all these cluster cores can be prepared in high yields by crystallization from methanol-water or ethanol-water mixtures. Since potassium and ammonium formate are very soluble in these alcohol-water mixtures, high formate concentrations could be accomplished in the solutions from which the corresponding salts of cluster formato complexes crystallized. The [Mo3O4]4+ compounds could be synthesized without requiring the use of noncomplexing acids in the process. Some [M3E4]4+ compounds were characterized by single-crystal structure determinations. [NH4]3.20[K]0.80[H3O][Mo3O4(HCO2)8][HCO2].H2O was triclinic, space group P1 (No. 2) with a = 11.011(2) A, b = 13.310(2) A, c = 9.993(1) A, alpha = 106.817(7) degrees, beta = 91.651(9) degrees, gamma = 88.340(9) degrees, and two formula units per cell. [K]6[W3S4(HCO2)9][HCO2].2.27H2O.0.73CH3OH was monoclinic, space group C2/m (No. 12) with a = 19.605(6) A, b = 14.458(7) A, c = 13.627(5) A, beta = 118.94(2) degrees, and four formula units per cell. Generally, the nine coordination sites of [M3E4]4+ were occupied either by a mixture of monodentate and mu 2-bridging formato ligands or by monodentate formato ligands only. By dissolution in noncomplexing strong acid, all the formato complexes immediately hydrolyzed to form [M3E4(H2O)9]4+ aqua complexes. This allows, for example, high concentrations of [Mo3S4(H2O)9]4+ in CF3SO3H to be obtained and these solutions to be used for the synthesis of bimetallic clusters containing the cubane-like motif Mo3M'S4.